Severe obesity is a common serious medical problem in the United States, and worldwide, with enormous health care costs. The problem continues to grow, reaching epidemic proportions. Central (android or abdominal) obesity in contrast to peripheral (gynoid) obesity has been shown to be associated with a higher morbidity/mortality which is usually measured by an increased waist: hip (W:H) ratio and is thought to be secondary to increased visceral adipose tissue (VAT) metabolism. We found that central obesity is also associated with an increased intra-abdominal pressure (IAP), which is more closely correlated with sagittal abdominal diameter (SAD) than W:H ratios and is associated with significant obesity co-morbidity including systematic hypertension, hypoventilation, idiopathic intracranial hypertension, gastroesophageal reflux lower extremity venous stasis and pretibial ulceration, and incisional hernias We have developed an externally applied device which lowers IAP. This grant is to support short-term studies to determine if lowering IAP deactivates the renin-angiotensin-aldosterone system, improves sodium excretion, blood pressure, ventilation (as measured by arterial blood gases and lung volumes), lumbar cerebrospinal fluid (CSF) pressure, internal jugular and femoral vein diameters and flows, and gastroesophageal reflux (as measured by an indwelling esophageal pH probe). The device will be applied in the Clinical Research Center at the Medical College of Virginia, Virginia Commonwealth University, for 8 hours for 5 days during the first week and then for 5 nights for 10 hour during the second week. If the data from these studies are supportive, subsequent investigation will be undertaken to evaluate the device when used a home at night for longer period of time to determine if it can have long-term positive effects on these co-morbid aspects of severe central obesity and is concordant with the health promotion objectives of "Healthy People 2000".